Ennis William J
Section of Wound Healing and Tissue Repair, University of Chicago, Chicago, Illinois 60612, USA.
Ostomy Wound Manage. 2010 Nov;56(11):61-9.
Triage is the process of prioritizing patient care based on need and available resources. Clinicians in wound clinics triage daily because time and resources never seem to be sufficient. The triage concept is taken to an extreme when a disaster strikes--the clinical goal of patient care transforms from the individual patient to providing the greatest good for the greatest number of patients. Situational awareness of system resources is of paramount importance in a disaster. Planning for surge capacity while simultaneously attending to patients who require immediate attention is a must. The recent earthquake in Haiti provided an opportunity to test those skill sets. Scores of clinicians volunteered their time and expertise, elevating wound care to the status of a clinical division. The experience of providing quality wound care despite a myriad of situational limitations suggests that busy wound clinics can learn valuable lessons from the realm of disaster management. The rate of under- and over-triage in wound clinics can be reduced by utilizing commonly collected outcomes and operational data. Patient safety improves when the hierarchy is flattened, communication is open, checklists are used, debriefings are held, and teamwork is encouraged. Reflecting on the working conditions in Haiti, it is clear that patients and clinicians benefit when success is measured by patient outcomes instead of individual accomplishments.
分诊是根据需求和可用资源对患者护理进行优先排序的过程。伤口诊所的临床医生每天都要进行分诊，因为时间和资源似乎永远都不够用。当灾难发生时，分诊的概念就会被推向极致——患者护理的临床目标从个体患者转变为为最多数量的患者提供最大的益处。在灾难中，对系统资源的态势感知至关重要。在为大量患者做好准备的同时，还要照顾那些需要立即关注的患者，这是必须要做的。海地最近发生的地震提供了一个检验这些技能的机会。许多临床医生自愿贡献他们的时间和专业知识，将伤口护理提升到了一个临床科室的地位。尽管存在诸多情况限制，但仍能提供高质量伤口护理的经验表明，繁忙的伤口诊所可以从灾难管理领域学到宝贵的经验教训。通过利用通常收集的结果和运营数据，可以降低伤口诊所分诊不足和过度分诊的发生率。当层级扁平化、沟通开放、使用检查表、进行汇报并鼓励团队合作时，患者安全会得到改善。反思海地的工作条件，很明显，当以患者结果而非个人成就来衡量成功时，患者和临床医生都会受益。
